Provider Demographics
NPI:1710593850
Name:HASSAN, MOHAMED (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:HASSAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5434 WINFORD DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-7454
Mailing Address - Country:US
Mailing Address - Phone:832-472-0067
Mailing Address - Fax:
Practice Address - Street 1:3811 CENTER ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-6596
Practice Address - Country:US
Practice Address - Phone:281-479-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX367151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice